Hospitals with more post-acute referrals have more readmissions, shorter stays

A new study published in Medical Care suggests that some hospitals may use post-acute care as a substitute for inpatient care, potentially leading to premature discharges and higher readmission rates.

Researchers, led by Greg Sacks, M.D., analyzed data for more than 112,000 patients at 217 hospitals across 39 states derived from Medicare claims, American Hospital Association annual surveys and a national surgery registry. They found wide variation in the number of patents individual hospitals refer to inpatient facilities, ranging from 3 to 40 percent.

Looking closer at the data, they found higher readmission rates and longer stays at facilities that are more likely to refer patients to inpatient facilities. Providers that most often referred patients to inpatient care had a likelihood of 24.1 percent for readmissions, compared to 21.2 percent for those that referred them least often. They found no such association for referrals to home healthcare.

Sacks and his team also determined teaching hospitals were more likely than non-teaching hospitals to refer patients to home healthcare, and that use of inpatient facilities correlated with shorter average length of stay.

The research team theorized the phenomenon may be the result of healthcare reimbursement policies that provide incentives for earlier discharges, and that further study is needed to determine the appropriateness of post-acute care.

Sacks, a resident in general surgery resident at UCLA, said in a statement that surgeons and hospitals have virtually no guidelines to help them determine the best post-acute care services for their patients--and that better recommendations could help reduce some of the variation in how the services are used and the costs associated with them.

The findings comes in the wake of a study that found a similar correlation between post-acute care and readmissions, with nearly 1 in 4 patients discharged to acute care facilities readmitted at least once in the next 30 days, with nearly half of those patients readmitted within the first two weeks.